I really need help selecting the best vein to use when putting in an IV. I have searched allnurses.com as well as the rest of the internet, and found lot's of techniques for putting in an IV, but most of them just say select a good vein. Well, there is my problem. What constitutes a good vein. What should I feel for when I am trying to find it?
These are some descriptions I have found so far:
"The cephalic, accessory cephalic, or basilic vein would be ideal"
"feel and anchor a vein"
"Using the index and middle finger of your nondominant hand, palpate the vessels. (Fingers on the nondominant hand tend to be more sensitive.) A healthy vein feels soft, elastic, resilient, and pulseless. If you feel a pulse, look elsewhere: Only arteries pulsate."
"Avoid inserting the catheter near vein valves, which appear as knots or feel bumpy. Insert the needle just above or a full catheter length below a valve."
"Avoid bifurcations, the Y where two veins meet. Insert the catheter just above or well below this area to keep the tip away from the valve located in the Y."
"Also when you palpate the vein, "bounce" your finger. Veins bounce, other things don't (like tendons).
Engorged veins have a kind of bouncy feeling to them. Educate your fingers to that feeling. "
So, all of the above are the best descriptions I have found, but I still struggle. I tried to put in 3 IV's on Friday, and I totally failed (I'm in nursing school and still learning). The question I have is:
1. Is there something else the feel of a good vein can be compared to. Example: pressing on a baloon. Do you have any examples for me?
2. Is the cephallic vein usually the best choice?
3. I have many tricks that have been discussed in previous posts that I have written down, but I just need to know how to pick the right vein. Everytime I failed, my preceptor picked a good vein and got it on the first stick. So I believe my problem is picking the right vein. She tried to explain to me why she did not choose the same vein as me, but I didn't really get it. What is it you feel for when you pick the vein?
From a person who has REALLY BAD VEINS!!!!! Look carefully before you stick. Get a good vein before you try.
Patients do not mind you taking your time. I would rather sit there and be proded, hit (a bit of a exaguration but since slapping the area brings veins out they do this), and generally have my hands and arms felt all over then be stuck multiple times.
I, sometimes, have better luck not using a tournequet. I've also been taught to not use tournequets with patients with high blood pressure because veins will blow about 90% of the time if you use one. Hope this helps. If first try and no luck, try without the tournequet it might help.
Lots of time looking, little time sticking. I was a really good stick before I started working at a place with an IV team (now I'm out of practice.) But I could RARELY get an antecub, something about the angle just never worked for me. Cephalics were my vein of choice if it was good. It's hard to describe that spongy bouncy feel of a good vein. I would suggest: Find a guy that's strong but not super built. Feel his cephalic. Chances are, that's a good vein and EXACTLY the feel you should be looking for.:)
I can't remember the last time I put something smaller than an 18g in someone, but when it comes to advice it's hard to give without having a real (NOT practice) arm to point out good veins that aren't often used.
A few things that I always tell and show new nurses..
-make sure you get the tourniquet on tight enough, especially if you are drawing blood from the IV prior to saline locking it... "tight enough" might mean slightly uncomfortable for some patients, but if it means one stick, they generally agree it's worth it in the end
-when you have someone with "rolling veins" (not to be confused with the 90% of patients who come in and say "I'm a really really hard stick - my veins roll - you need to call in an anesthesiologist to put an IV in me" *yeah right*), look for a "Y". go right into the V or the "crotch" if you will... LOL... that prevents the vein from rolling away and allows you to easily start an IV without digging around or poking over and over against a vein that bends and curves against the needle but doesn't want to be poked.
-never underestimate the power of warm blankets, warm moist packs, etc. wrap a patient's arms for 5-10 minutes and see what you find afterward.
-sometimes you need to find your favorite veins -- for some odd reason they become the easiest to stick.
Good technique is important too. Check YouTube.com and watch the videos -- there are tons of military staff who seem to like to videotape themselves starting IVs and put it all out there for people to watch, which is kind of a nice learning tool for new RNs.
What else? In my opinion, bigger is better as long as you have an appropriate sized vein. I generally won't go smaller than an 18g unless I've TRIED an 18g and simply can't find anything at ALL. The larger gauge IVs allow you to feel a very slight "pop" when you go in one side of a vein, letting you know you need to stop, lower the angiocath, advance the needle a tiny bit more, and then advance the cannula & retract the needle... smaller gauge IVs are more prone to slide in one side of a vein and out the other. I've put several 18g's in the anterior/underside of wrists -- the veins look small but in a bind when you need IV access and need to be able to give a ton of fluids, it works!
I find the best veins are on the inside of the forearm. They are the easiest to visulize and usually have the longer straight runs. Learn where the anesthesiologist sure bet is. Its a little difficult to get to but worth it if you cant find anything else. Sometimes there is one that runs along side the bicep that can be easily found. I know one person said find the antecubital and stick that one. Thats fine if you dont mind getting scourged by the next shift when the pump goes off every time someone bends their arm.
It will come, its like baseball, sometimes you can hit a home run and sometimes you cant hit the broad side of a barn with a hand grenade.
Thank you again for all the suggestions. QueenElisabeth2, I am not getting a flash. The first stick my preceptor said she thought I was on top of the vein and my angle was to flat. The second time she said it looked like I was on the side of the vein. Third time she didn't say. I have requested another night in the ER from my instructor, and if I get it I will have a chance to try again.
Alkaleidi, we were told in school due to new regulations, we are not allowed to practice on each other or co-workers. If we are found to do so, we may be dismissed from the program. I wish it wasn't so, but nothing is worth being dismissed, so I practice on the poor patients. Next time I will bring a warm blanket with me when I bring in the supplies and put it on the patients arm before I put on the tourniquet. That will hopefully help. I'l check Youtube, I hadn't thought about that one. I found a great army powerpoint which had good pictures, but I will try youtube for videos.
Keep practicing. For me..what helped...was starting alot. My preceptor was understanding..and if I didn't see one I was willing to try..she let me to anticubital for the first few. (easier to hit) When I felt comfortable- I started going for others in the hand/ forearm.
Thank you again for all the suggestions. QueenElisabeth2, I am not getting a flash. The first stick my preceptor said she thought I was on top of the vein and my angle was to flat. The second time she said it looked like I was on the side of the vein. Third time she didn't say. I have requested another night in the ER from my instructor, and if I get it I will have a chance to try again.
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I think what might help you is to learn the feel of a vein while not looking at it (after the tourniquet is applied). Turn your head away and just feel the vein, then move your fingers to either side of it to determine it's width. After you get a visual in your mind based on the 'feel', track the vein above and below the site you found. You certainly can practice this part on yourself and others.
Only after you do this sightless investigation, repeat the same while looking. When you are ready to go for it, use your fingernail to indent where you will stick. Try to pick a point just above where you lose the feel for the vein (if there isn't a valve). Feel where your needle is in relation to the vein immediately after you make the stick, if you do not get flashback. Adjust your needle angle to get to the vein you are feeling and only watch for flashback, not for the vein. The moment you get flashback stop and advance the cath a little bit while advancing the needle even less. Because you felt the vein, you should be familiar with the proper angles to proceed & if anchoring is needed (eg, vein moving over every time the needle hits it needs to be anchored before the next attempt to move the needle).
Sometimes, I will completely turn my head away in order to concentrate on feeling for those deep veins. Now, I do have to add that I am not a visual learner; so, I think, that has a lot to do with why this method has worked for me.
It took me a long time to get the hang of putting IVs in. With practice, it no longer became a source of anxiety.
Our CT techs require at least a 20g in the AC for contrast infusion. So if they are going to CT (who doesn't in the ER???), then that's where they go.
Just be sure to pull wrinkly skin taut before sticking. I'll use the tourniquet just to hold it up and out of the way on an elderly patient with papery skin - just not tied tightly.
Keep practicing. Don't get discouraged, no one is an expert IV inserter by their third stick!!
I'm so excited, I put in the perfect IV on Friday, on the FIRST TRY. I chose the perfect vein (in the hand), IV went in perfectly. It flushed, and I am so happy I did it. Now, I have to admit that my patient was on a vent and unconscious, but I did it.:)
(I'm in nursing school and still learning). The question I have is:
lpnstudentin2010, LPN
1,318 Posts
From a person who has REALLY BAD VEINS!!!!! Look carefully before you stick. Get a good vein before you try.
Patients do not mind you taking your time. I would rather sit there and be proded, hit (a bit of a exaguration but since slapping the area brings veins out they do this), and generally have my hands and arms felt all over then be stuck multiple times.